Just-in-time evidence-based e-mail "reminders" in home health care: impact on patient outcomes

Health Serv Res. 2005 Jun;40(3):865-85. doi: 10.1111/j.1475-6773.2005.00389.x.


Objective: To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients.

Data sources/study setting: Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF.

Study design: Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources.

Data collection: Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use.

Principal findings: Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p< or =.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p< or =.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes.

Conclusions: This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Community Health Nursing / standards*
  • Diffusion of Innovation
  • Disease Management*
  • Electronic Mail*
  • Evidence-Based Medicine*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Heart Failure / nursing
  • Heart Failure / prevention & control*
  • Heart Failure / psychology
  • Home Care Services / standards*
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care*
  • Patient Education as Topic
  • Practice Guidelines as Topic*
  • Reminder Systems*
  • Self Care
  • United States